 |
 |
 |
|
The peritoneum is the membrane that lines the abdominal cavity and covers organs. When it becomes inflamed, the disease is called peritonitis.
This condition can be confused with intraabdominal abscess (abdominal abscess), which involves a collection of pus in the abdomen that may cause peritonitis. Before peritonitis develops, it can still cause symptoms that are similar or identical to peritonitis.
There are three main types of peritonitis: spontaneous, secondary, and peritonitis associated with dialysis.
Causes & Development
Also known as spontaneous bacterial peritonitis, spontaneous peritonitis is an infection that occurs as a complication of ascites (a collection of fluid in the peritoneal cavity). Most cases of bacterial peritonitis occur as a result of ascites due to chronic liver disease, or in kidney failure patients undergoing peritoneal dialysis. In the latter case, the cause of spontaneous peritonitis is infection in the blood that spreads to the peritoneal fluid, usually from a contaminated peritoneal dialysis catheter.
Risk factors for liver disease include alcoholic cirrhosis and other diseases that lead to cirrhosis, such as viral hepatitis. Patients with kidney failure can develop nephrotic syndrome, which leads to ascites and can then become infected.
Secondary peritonitis is secondary to (caused by) another condition, most commonly the spread of an infection from the digestive organs or bowels. Bacteria may enter the peritoneum via a hole in the gastrointestinal tract, which can be caused by a ruptured appendix, stomach ulcer or perforated colon. The condition can also occur when pancreatic enzymes leak into the peritoneum during pancreatitis or when bile leaks from the biliary tract due to injury because these chemicals can irritate the peritoneum. Foreign contaminants can also cause secondary peritonitis if they get into the peritoneal cavity. This can occur during use of peritoneal dialysis catheters.
Peritonitis associated with dialysis (PAD) is an acute or chronic inflammation (irritation and swelling) of the peritoneum (lining of the abdomenal cavity) that occurs in people receiving peritoneal dialysis. The cause of dialysis-associated peritonitis may be the introduction of bacteria into the peritoneum by the dialysis procedure. Skin bacteria are the most common organisms causing infection. Incidence is about one infection for every 15 months of peritoneal dialysis.
Signs & Symptoms
(General) signs and symptoms include:- Abdominal pain
- Abdominal tenderness
- Abdominal distention
- Fever
- Low urine output
- Nausea and vomiting
- Point tenderness
- Thirst
- Fluid in the abdomen
- Inability to pass feces or gas
Additional symptoms that may be associated with this disease include cloudy dialysis fluid (if undergoing peritoneal dialysis); nausea and vomiting; shaking chills; signs of shock.
Specific signs and symptoms of spontaneous peritonitis include: Fluid in the abdomen; abdominal pain and distention; tenderness; decreased bowel sounds; inability to pass feces or gas; fever; thirst; low urine output, nausea and vomiting, joint pain, chills.
Signs and symptoms of secondary peritonitis include: Abdominal pain; abdominal distention; fever; thirst; low urine output. There may also be signs of shock.
Signs and symptoms of PAD include abdominal tenderness; distended abdomen; nausea and vomiting; cloudy dialysis fluid; fever; chills.
Diagnosis & Tests
Laboratory findings:- Ascitic fluid - turbid, bloody, may contain fat globules; increased WBC; Gram's stain and aerobic and anaerobic cultures show multiple organisms; increased amylase; increased mononuclear cells and decreased glucose occur in tuberculous peritonitis
- Leukocytosis - up to 50,000/ul with 80-90% neutrophils; may not occur in older patients
- Increased haemoglobin, haematocrit, and BUN - reflect haemoconcentration secondary to extracellular fluid loss into the peritoneal cavity
- Laboratory findings of any of the underlying conditions.
Treatment & Prevention
Treatment of spontaneous peritonitis depends on the cause; surgery may be needed in cases where peritonitis is asociated with a foreign object, such as a peritoneal dialysis catheter. Antibiotics are administered to control infection in cases of spontaneous peritonitis in patients with liver or kidney disease, and dehydration is treated by intravenous therapy. Hospitalization is common and may be necessary to rule out other causes of peritonitis such as appendicitis and diverticulitis.
Surgical treatment of secondary peritonitis is usually necessary to remove sources of infection such as infected bowel, inflamed appendix, or an abscess. General treatment includes intravenous fluids, antibiotics, and use of medications to treat pain.
The goal of treatment in PAD cases is to cure the infection. Antibiotics are given into a vein (intravenous injection) and/or into the peritoneum. The antibiotic will be specific to the organism recovered in cultures of blood or peritoneal fluid.
Prognosis; Complications
The infection can usually be treated, but the prognosis for spontaneous peritonitis patients may be poor because of underlying kidney or liver disease. People with these conditions often respond to antibiotics but may still have a poor outcome.
The outcome of secondary peritonitis depends on the underlying cause, the duration of symptoms before treatment, and the general health of the patient. Outcomes can range from complete recovery to overwhelming infection and death, depending on these factors.
Most PAD patients recover completely.
Complications of spontaneous peritonitis may include abscess development; intestinal obstruction from scar tissue; hepatorenal syndrome; hepatic encephalopathy; massive sepsis (inflammation of peritoneal cavity caused by bacteria can result in infection of the bloodstream - sepsis - and severe illness.)
Possible complications of secondary peritonitis include septic shock, abscess or intraperitoneal adhesions.
PAD complications can include recurrent peritonitis, intraabdominal abscess, catheter tract infection (removal of the dialysis catheter may be necessary.)
|
|
 |
|
 |
Risk factors for Peritonitis: | | | | | Digestion |  Gastric/Peptic/Duodenal Ulcers | Sometimes an ulcer eats a hole in the wall of the stomach or duodenum. Bacteria and partially digested food can spill through the opening into the sterile abdominal cavity, called the peritoneum. This causes peritonitis, an inflammation of the abdominal cavity and wall. A perforated ulcer usually requires immediate hospitalization and surgery. |
|
| | | | |
KEY | | Weak or unproven link |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Aerobic (Aerobically)
Using oxygen. For example, aerobic exercises such as running, swimming, bicycling or playing tennis use up lots of oxygen and burn up lots of calories and fat.
Amylase
A starch-digesting enzyme.
Anaerobic (Anaerobically)
Of, relating to, or being activity in which the body incurs an oxygen debt (for example weight training or resistive exercises) and does not immediately burn off a lot of calories and fat.
Ascites
Accumulation of serous fluid in the abdominal cavity.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Bile
A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.
Boil (Abscess, Abscesses, Boils, Carbuncle, Carbuncles, Cystic Acne, Furuncle, Furuncles, Hidradenitis Suppurativa, Pilonidal Cyst, Pilonidal Cysts)
A localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with white cells that the body sends to fight the infection (pus). Finally, the pus forms a "head" and drains out through the skin. A furuncle or carbuncle is an abscess in the skin caused by the bacteria Staphylococcus aureus. It can have one or more openings onto the skin and may be associated with a fever or chills. Cystic acne is a type of abscess formed when oil ducts become clogged and infected. Cystic acne is most common in the teenage years. Hidradenitis suppurativa is an illness in which there are multiple abscesses that form under the arm pits and in the groin area. These areas are a result of local inflammation of the sweat glands. A pilonidal cyst is a special kind of abscess that occurs in the crease of the buttocks. These frequently form after long trips that involve sitting.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Chronic Renal Failure (Chronic Renal Insufficiency, Kidney Failure, Renal Insufficiency)
(CRF) Irreversible, progressive impaired kidney function. The early stage, when the kidneys no longer function properly but do not yet require dialysis, is known as Chronic Renal Insufficiency (CRI). CRI can be difficult to diagnose, as symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include a frequent need to urinate and swelling, as well as possible anemia, fatigue, weakness, headaches and loss of appetite. As the disease progresses, other symptoms such as nausea, vomiting, bad breath and itchy skin may develop as toxic metabolites, normally filtered out of the blood by the kidneys, build up to harmful levels. Over time (up to 10 or 20 years), CRF generally progresses from CRI to End-Stage Renal Disease (ESRD, also known as Kidney Failure). Patients with ESRD no longer have kidney function adequate to sustain life and require dialysis or kidney transplantation. Without proper treatment, ESRD is fatal.
Cirrhosis (Liver Cirrhosis)
A long-term disease in which the liver becomes covered with fiber-like tissue. This causes the liver tissue to break down and become filled with fat. All functions of the liver then decrease, including the production of glucose, processing drugs and alcohol, and vitamin absorption. Stomach and bowel function, and the making of hormones are also affected.
Colon (Colonic)
The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.
Dialysis
The artificial process of cleaning wastes from the blood when kidneys fail.
Distention (Distended)
An excess expansion of a tissue or organ, either from inflammation, injury or gas.
Diverticular Disease (Diverticulitis, Diverticulosis)
Some people develop small pouches (diverticula) that bulge outward through weak spots in the colon. Diverticulosis is the condition of having these pouches; diverticulitis is an inflammation or infection in these pouches. The conditions diverticulosis and diverticulitis are both referred to as diverticular disease. Diverticulosis may not cause any symptoms but could include mild cramps, bloating and constipation - all of which are common to other conditions such as IBS or ulcers. The most common symptoms of diverticulitis are abdominal pain and tenderness around the left side of the lower abdomen. When infection is the cause, fever, nausea, vomiting, chills, cramping and constipation may also occur.
Duodenum (Duodenal)
First portion of the small intestine between the pylorus and jejunum, connecting to the stomach.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Glucose
A sugar that is the simplest form of carbohydrate. It is commonly referred to as blood sugar. The body breaks down carbohydrates in foods into glucose, which serves as the primary fuel for the muscles and the brain.
Hepatitis
Inflammation of the liver usually resulting in jaundice (yellowing of the skin), loss of appetite, stomach discomfort, abnormal liver function, clay-colored stools, and dark urine. May be caused by a bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins or transfusion of incompatible blood. Can be life-threatening. Severe hepatitis may lead to cirrhosis and chronic liver dysfunction.
Intraperitoneal
In the peritoneal cavity underlying the abdomen, often referring to the location of experimental injections.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Leukocytosis
Having abnormally high numbers of white blood cells, usually the result of a non-viral infection.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Microliter (uL)
0.000001 or one millionth of a liter.
Nausea
Symptoms resulting from an inclination to vomit.
Neutrophils (Neutrophil)
Another name for polymorphonuclear leukocytes, the most common type of blood-carried white blood cell, and the first mobile resistance cell to come to the rescue in injury.
Pancreas (Pancreatic)
Opposite the liver and behind the stomach, the pancreas has two main functions - to manufacture various enzymes for digestion, and to release hormones to help control the body's use of carbohydrates. It releases insulin to help each cell absorb glucose to burn as energy. In this way, insulin controls the amount of sugar (glucose) in the blood. Proper pancreatic function is very important: too much, too little, or no insulin production can be life-threatening. Some of the chemicals released by the pancreas are not hormones, but stimulate other glands to make hormones. Once again, balance is necessary. Nutritional requirements for the pancreas are many. Research indicates that chromium vitamins C, E, B-complex, calcium, magnesium and potassium are especially important.
Pancreatitis
Inflammation of the pancreas. Symptoms begin as those of acute pancreatitis: a gradual or sudden severe pain in the center part of the upper abdomen goes through to the back, perhaps becoming worse when eating and building to a persistent pain; nausea and vomiting; fever; jaundice (yellowing of the skin); shock; weight loss; symptoms of diabetes mellitus. Chronic pancreatitis occurs when the symptoms of acute pancreatitis continue to recur.
Peritoneum
Serous sac lining the abdominal cavity and covering most of the organs inside it.
Prognosis
A prediction (estimate) of the future course and outcome of a disease and an indication of the likelihood of recovery from that disease.
Pus
White cells that the body sends to fight an infection.
Scar Tissue
Fibrous tissue replacing normal tissues destroyed by injury or disease.
Sepsis (Blood Poisoning, Septicemia)
Like septicemia, an infection that has moved deeply into the body, involving the subcutaneous or submucosal layers, connective tissue, lymph system, or blood. Septicemia: The presence of pathogenic bacteria or other microbes in the blood stream - a serious business, since most defenses are focused outside the bloodstream and the infection has bypassed them either due to its virulence, the depth and severity of the original focal infection or the weakened state of the body's immunity and life energy. Blood poisoning.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Ulcer (Ulceration, Ulcers)
Lesion on the skin or mucous membrane.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
Last updated: Apr 13, 2008
|
 |
|
|
